2006 OPEN FORUM Abstracts
SAFETY OF NON-BRONCHOSCOPIC BAL PERFORMED BY RESPIRATORY THERAPISTS: EXPERIENCE FROM A LARGE ONCOLOGICAL ICU
Clarence Finch BS, BA, RRT, S. Egbert Pravinkumar MD,
FRCP, FCCP, Joseph L. Nates, MD, MBA, FCCM, George Geevarghese, RRT, Kim Meek, RRT,
Reed Perkins, RRT, Cindy Han, MBA, RRT, Kristen J. Price MD, FCCP.
Background: The
risk of VAP is considered high in ventilated critically ill cancer patients
compared to non-cancer patients. Both bronchoscopic bronchoalveolar lavage (B-BAL)
and non-bronchoscopic BAL (NB-BAL) procedures are commonly used for
microbiological analysis in ventilated patients. The NB-BAL is carried out by
respiratory therapist (RT) with significant cost advantage, when compared to B-BAL.
However, there is a general concern that NB-BAL technique could undermine patient
safety, since this is done without direct visualization of lower airways in
high risk patients, such as hematological malignancy and also because it is
performed by non-physicians. We investigated the safety of NB-BAL performed by
RT in our medical and surgical oncological ICU.
Methods: All NB-BAL
procedures between September 2004 and January 2006 were reviewed in the
respiratory care database for reported complications. The data was collected as
part of ongoing respiratory care quality assurance program. The NB-BAL
procedures were done by RT according to an established departmental protocol;
using Kimberley Clark protected 16 Fr BAL catheter. The protocol included
mandatory reporting of the occurrence of any pre-defined complication.
Results: During the study period, a total of 109 patients underwent
RT performed NB-BAL in our oncological ICU. In 90% of patients who underwent
NB-BAL, no procedure related adverse events were noted. There were no major complications such as
bronchospasm, pneumothorax, hemoptysis and bleeding post procedure. Minor
complications - blood tinged BAL 5%, tachycardia 2%, and oxygen desaturation 2%,
systolic pressure variation 1% were noted. No patient died or clinically
deteriorated as a result of NB-BAL procedure.
Conclusion: Non-bronchoscopic BAL technique can be
readily and safely performed by RT in selected group of critically ill cancer
patients. No major adverse events were noted with this procedure in cancer
patients despite the high incidence of neutropenia, thrombocytopenia and
coagulation abnormality in this population. Presence of a carefully designed NB-BAL
policy improved operator confidence and patient safety.